Active NPI
Jessica Anna Pettit, LCSW
- Social Worker
- Holbrook, NY
National Provider Identifier
1295140804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 094187
- Practice address
- 321 Dante CT Ste 6
Holbrook, NY 11741-3842 - Phone
- (631) 416-4011
- NPI assigned
- Jun 23, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 094187 | NY | Primary |
Addresses
Primary practice location
321 Dante CT Ste 6
Holbrook, NY 11741-3842
Mailing address
14 Norfolk Dr
Northport, NY 11768-1031
Phone (631) 416-4011
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 089107-1 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1403481600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786838400000",
"number": "1295140804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14 NORFOLK DR",
"city": "NORTHPORT",
"state": "NY",
"postal_code": "117681031",
"telephone_number": "631-416-4011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "321 DANTE CT STE 6",
"city": "HOLBROOK",
"state": "NY",
"postal_code": "117413842",
"telephone_number": "631-416-4011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTIT",
"first_name": "JESSICA",
"middle_name": "ANNA",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-06-23",
"last_updated": "2026-08-16",
"certification_date": "2026-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "094187",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holbrook, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.